Abstract: :
Purpose: To emphasize the beneficial effect of photodynamictherapy (PDT) on the size of the choroidal neovascular (CNV)lesion and evolution of the disciform scar (DS) in patientswith predominantly classic subfoveal choroidal neovascularization(PCSFCNV), a probably underestimated benefit of PDT.Methods:Retrospective chart review of all patients who received PDTfor subfoveal CNV (SFCNV) at the University of Virginia HealthSystem during the years of 2000 and 2001. Only eyes that metthe inclusion criteria of the study were included. In each studyeye, the greatest linear dimension (GLD) of the treated lesionwas recorded before and at the last follow up after PDT. Analysisof the GLD before and after treatment and measurement of thesize of the potential DS post PDT were performed. Furthermore,a subgroup of patients who already had a DS in their felloweye at presentation was studied. The size of the scar in thissubgroup of eyes was compared to that of the potential scarin the study eyes of these patients and the rest of the patients.Results: During the specified period, 148 patients receivedPDT for SFCNV. Sixty-two eyes of 60 patients met the inclusioncriteria of the study. Of these eyes, 95% had PCSFCNV due toage-related macular degeneration and 5% had similar lesionsrelated to pathologic myopia and presumed ocular histoplasmosissyndrome. After an average follow up of 9-month, the size ofthe CNV lesion was stabilized or reduced in 64% of the studyeyes while 36% had progression of the lesion. Forty five percentof the treated eyes had no evidence of CNV at last follow up.Only 3 study eyes (5%) developed DS following treatment. Fourteenpatients (23%) had already had DS in their fellow eye at thetime of the study and none of these eyes had previously receivedPDT. The size of the scar in these eyes was significantly largerthan that of the potential scar in the study eyes of the same14 patients and of the remaining patients.Conclusions: Thisstudy documents the beneficial effect of PDT on the size ofthe CNV lesion and on the evolution of the DS in PCSFCNV. Thisbenefit has been probably overshadowed because of the emphasisthat ophthalmologists invest in the direction of final visualacuity outcome. A smaller size of the CNV lesion and subsequentscar might be of great significance to patients, particularlythose in whom PDT fails to prevent severe vision loss.